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INTRODUCTION: We aimed to compare the detection rate of prostate cancer (PCa) and clinically significant (cs) PCa by magnetic resonance imaging-guided targeted biopsy (MTBx) alone and MTBx plus systematic biopsy (SBx) using an outpatient transperineal (TP) approach under local anesthesia. METHODS: A retrospective study of patients who underwent outpatient TP prostate biopsy under local anesthesia at our tertiary institution between 2019 and 2022 was performed. To compare the proportions of PCa and csPCa in both pathways, McNemar's tests were used. Multivariable logistic regression model was fitted to determine the predictors of csPCa. RESULTS: Of 255 men included, 177 (69%) underwent MTBx alone. MTBx had similar detection rate for PCa (56%) and csPCa (47%) compared to the combination of MTBx and SBx (PCa 61%; csPCa 49%; p=0.1 and p=0.3, respectively). MTBx had lower median number of biopsy cores compared to the combination of MTBx and SBx (6 vs. 11, p<0.001). At multivariable logistic regression analysis, age (odds ratio [OR] 1.08, 95% confidence interval [CI] 1.04-1.13, p<0.001), prior negative biopsy (OR 0.19, 95% CI 0.09-0.44, p<0.001), prostate-specific antigen density cutoff =0.15 (OR 3.17, 95% CI 1.67-6.01, p<0.001), and prostate imaging reporting and data system =4 (OR 12.2, 95% CI 4.21-35.6, p<0.001) were independent predictors of csPCa. CONCLUSIONS: MTBx showed similar diagnostic performance to the combination of MTBx and SBx in patients undergoing outpatient TP prostate biopsy. Future studies are needed to evaluate the role of MTBx in avoiding unnecessary biopsies. [ABSTRACT FROM AUTHOR]

Objectives: Multiparametric magnetic resonance imaging (mpMRI) has made dramatic inroads into the management of localized prostate cancer (PCa); however, not all suspicious lesions represent clinically significant (cs) PCa. We aimed to analyze the hypothetical effect of incorporating tumor volume ratio (TVR) into prostate biopsy (PBx) decision-making. Materials and Methods: Two hundred and fifty-two patients with suspicious lesions at mpMRI undergoing transperineal PBx under local anesthesia between 2019 and 2022 were retrospectively evaluated. TVR was calculated by dividing the tumor volume by the prostate volume. A regression model was used to assess predictors of csPCa. Descriptive statistics were applied to evaluate the effect of including TVR in PBx decision-making. Results: Overall, 119 patients (47%) were found to have csPCa. Age ( p < 0.001), prior negative PBx ( p = 0.011), and TVR ( p < 0.001) were found to be independent predictors of csPCa. Applying the TVR cutoff of 0.23, a total of 117/252 (46%) PBx would have been avoided at the cost of missing csPCa in 26 (10%) men. Conclusions: Age, previous biopsy status, and TVR were found to be independent predictors of csPCa in men with suspicious lesions at mpMRI. Implementation of TVR into PBx decision-making improves the accuracy of mpMRI. Future studies are required to validate our findings and evaluate the role of TVR in avoiding unnecessary PBx.

Aim: To represent mathematically the intersection between the ectatic corneal geometry and the plane of intracorneal ring implants (ICRS) in order to determine the corneal response to ICRS surgery in keratoconus (KC). Thereafter, to present the concept and early results of a newly derived topography-guided nomogram for ICRS surgery for the treatment of keratectasia., Methods: The corneal rings plane intersection was modelled to a conic section. Ring effect was the result of: the ring size, position (steep vs flat), location (distance from the geometric centre of the cornea), and the discrepancy between the ring's curvature and the tunnel's curvature. Femtosecond laser was used to create the tunnels and the incision sites were chosen according to the nomogram in order to place the thickest ring in the steepest portion of the cornea regardless of the astigmatism axis of refraction., Results: The conic section had a more prolate shape in the steep area of the cornea than in the flat area, depending on the corneal sagittal curvature. Equal ring size had more flattening effect in the steep area than in the flat area. Thick segment should be implanted under the steep portion of the cornea regardless of the cylinder axis of refraction. Single segment in the steep area was sufficient in early and moderate cases of KC. The new nomogram provided more topographic regularity with significant reduction of astigmatism and better improvement in uncorrected visual acuity (UCVA) and best-corrected visual acuity (BCVA) than the conventional nomogram., Conclusion: The newly derived nomogram can produce better results than the conventional nomogram. Moreover, based on this concept, a new nomogram can be integrated into the femtosecond laser software to create topography-guided, customized, elliptical tunnels with modified focal asphericity that allows for customized focal flattening of the irregularly steepened ectatic cornea.